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Risk Factors And Outcomes Associated With Thoracic Complications After Hepatectomy: A Single-Center Experience
*Katelyn Flick, *Thomas Maatman, *Mazhar Soufi, *Cameron Colgate, *Madeline Blackwell, *Kayla Chin, *Trang Nguyen, *Duykhanh Ceppa, Attila Nakeeb, Michael House, Christian Max Schmidt, Eugene Ceppa
Indiana University, Indianapolis, IN

Objective
Thoracic complications (TC) are a common cause of postoperative morbidity in patients undergoing hepatectomy. Complications range from mild to those requiring surgical intervention. This study aimed to identify risk factors, define severity, and evaluate the impact of TCs on postoperative morbidity following hepatectomy.
Methods
Retrospective review of patients undergoing hepatectomy at a single institution from 2013-2018 was performed. Severe TC included those with acute respiratory failure, pneumothorax, pneumonia, biliopleural fistula, pulmonary embolus, complex pleural effusion, re-intubation, or those requiring invasive intervention. Univariate analysis was used to identify baseline differences. Potential confounders were controlled for in multiple regression models.
Results
Of the 702 patients undergoing hepatectomy, severe morbidity secondary to TC was observed in 38 patients (5%). Patients developing TC after hepatectomy were older (TC, 60.8 years; no-TC, 57.4 years; P = 0.01), more frequently had hypertension (TC, 55%; no-TC, 41%; P = 0.0005), chronic obstructive pulmonary disease (TC, 10%; no-TC, 5%; P = 0.045), or non-home admission origin (TC, 10%; no-TC, 5%; P = 0.02). Preoperative and perioperative variables identified on multivariable analysis as risk factors for the development of TC after hepatectomy are shown in Figure 1. Multivariable analysis revealed that patients developing any postoperative TC had significantly increased postoperative morbidity including prolonged hospital stay (TC, 11.4 days; no-TC, 5.6 days; P = <0.001) and hospital readmission (OR, 2.3; 95% CI, 1.3-4.0; P =0.007). Thirty-day mortality was 2%; no difference in mortality was observed between patients that developed TC (4%) and patients without TC (1%), P =0.07.
Conclusion
Chronic obstructive pulmonary disease, major hepatectomy, malignant pathology, and excess intravenous fluid 24 hours postoperatively are risk factors for thoracic complications after hepatectomy. Strategies to reduce thoracic complications should be implemented in high-risk patients to reduce postoperative morbidity.


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